Early and late recurrence after liver resection for hepatocellular carcinoma. Prognostic and therapeutic implications

OBJECTIVE: To evaluate the predictive factors, the therapy, and the prognosis of intrahepatic recurrence (IR) after surgery for hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: The predictive factors of IR are debated. To class the recurrence according to the modality of presentation may help to find a correlation and to select the right therapy for the recurrence. METHODS: A total of 213 patients were evaluated. Risk factors for recurrence were related to time (<2 years and >2 years) and type of presentation (marginal, nodular, and diffuse). Prognosis and therapy for the recurrence were studied in each group of patients. RESULTS: IR was observed in 143 patients; 109 were early (group 1) and 34 late recurrences (group 2). Cirrhosis, chronic active hepatitis (CAH) and HCV positivity were independently related to the risk of recurrence with a cumulative effect (92.5% of recurrences in patients with 3 prognostic factors). For group 1, the neoplastic vascular infiltration together with cirrhosis, HCV positivity, CAH, and transaminases were significant; all the 11 patients with 5 negative prognostic factors showed an early recurrence. On the contrary, only cirrhosis was related to a late recurrence. Survival rate was significantly better in late than in early recurrence (61.9%, 27.1% and 25.7%, 4.5% at 3-5 years); a curative procedure was performed in 67.6% in group 1 and 29.3% in group 2. After a radical treatment of IR, the survival was comparable with the group of patients without recurrence. CONCLUSIONS: Early and late recurrences are linked to different predictive factors. The modality of presentation of the recurrence together with the feasibility of a radical treatment are the best determinants for the prognosis.